SPARK Reading Donation Form

Are you the student's parent or legal guardian?*

How many children participated in SPARK?*

How many children are you sponsoring?*

Student 1 Name*

First Last

Student 1 - Grade/Teacher*

Student 1 - Hours Read*

Student 1 - Donation Amount*

Student 2 Name*

First Last

Student 2 - Grade/Teacher*

Student 2 - Hours Read*

Student 2 - Donation Amount*

Student 3 Name*

First Last

Student 3 - Grade/Teacher*

Student 3 - Hours Read*

Student 3 - Donation Amount*

Student 4 Name*

First Last

Student 4 - Grade/Teacher*

Student 4 - Hours Read*

Student 4 - Donation Amount*

Contact Information

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Additional Giving Options

PayPal (Select One)*

Donate 100% - Add 3% so that 100% of the donation goes to Dilworth Elementary.
Donate 97% - I understand Paypal, Inc. will deduct 3% to cover transaction costs.

Donate 100% - Add 3% so that 100% of the donation goes to Dilworth Elementary.

Price: $0.00

Is this donation eligible for corporate matching?

Company Name*

Other
Bank of America
Duke Energy
Wells Fargo

Company Name*

Donation Total

$0.00

Credit card payments can be done through PayPal

Payment Option

Captcha

To prevent spam, solve this simple math problem above.

Paypal

You will be directed to Paypal to make payment after form is submitted.

Contact Information

Additional Giving Options

Paypal

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